June 28, 2017

Anti-MOC Laws Picking Up Steam Across the United States

Lawmakers across America have started to take a variety of matters into their own hands, the most recent of which is Maintenance of Certification (MOC) licensure requirements. This trend started late last year when Oklahoma became the first state to pass legislation that prohibited MOC as a condition of medical licensure and hospital admitting privileges.

So far seven states (Georgia, Maryland, Missouri, North Carolina, Oklahoma, Tennesse and Texas) have passed laws that prevent hospitals, licensing boards, insurance companies and health systems from requiring MOC. Bellow is a summary of bills and laws in states taking MOC under consideration.

Alaska

The Alaska State Legislature has introduced legislation, HB 191 – An Act relating to the practice of medicine and osteopathy, that stated, “Maintenance of Certification and osteopathic continuous certification. Nothing in this chapter may be construed to require a physician to secure a maintenance of certification as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in this state.” The legislation was referred to the Health and Social Services Committee on March 22, 2017, and no further action has been taken.

California

California Senate Bill 487 – Practice of Medicine: Hospitals was introduced in February 2017, and has yet to be heard by the committee, though it was set for hearing twice (and canceled twice). The relevant portion of the legislation reads, “The regular practice of medicine in a licensed general or specialized hospital having five or more physicians and surgeons on the medical staff, which does not have rules established by the board of directors thereof of the hospital to govern the operation of the hospital, which rules include, among other provisions, all the following, constitutes unprofessional conduct: … (c) Provision that the award or maintenance of hospital or clinical privileges, or both, shall not be contingent on participation in a program for maintenance of certification.”

Florida

Florida had legislation introduced in the state House of Representatives that would have prohibited that Boards of Medicine and Osteopathic Medicine and the DOH from requiring certain certifications as conditions of licensure, reimbursement, or admitting privileges. The bill, fortunately, never made it out of Committee discussions.

Georgia

Georgia’s legislation that prohibits MOC from being required as a condition of licensure was signed by the Governor on May 8, 2017, and is effective as of July 1, 2017. The relevant language states, “maintenance of certification shall not be required as a condition of licensure to practice medicine, staff privileges, employment in certain facilities, reimbursement, or malpractice insurance coverage; to provide for definitions; to provide for related matters; to repeal conflicting laws; and for other purposes.”

Maine

Both houses of the Maine legislature have introduced legislation that aims to change the way physicians and surgeons are licensed. Relevant language states, “Nothing in this chapter may be construed to require an osteopathic physician or surgeon licensed under this chapter to secure a maintenance of certification as a condition of licensure, reimbursement, employment or admitting privileges at a hospital in the State.” The passed legislation is currently awaiting the governor’s signature.

Maryland

The Maryland legislation has been passed by both the House and Senate, and was signed by Governor Larry Hogan and will become effective on October 1, 2017. The relevant language states, “The Board may not require as a qualification to obtain a license or as a condition to renew a license certification by a nationally recognized accrediting organization that specializes in a specific area of medicine; or maintenance of certification by a nationally recognized accrediting organization that specializes in a specific area of medicine that includes continuous reexamination to measure core competencies in the practice of medicine as a requirement for maintenance of certification.”

Massachusetts

Bill H.2446 was introduced in the Massachusetts House of Representatives in January 2017, but did not make it into law. The relevant language of the legislation stated, “Nothing in this Chapter shall be construed as to require a physician to secure a Maintenance of Certification (MOC) as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in this state.”

Michigan

The Michigan legislature introduced two separate bills relating to MOC, HB 4134 and HB 4135. The two bills, neither of which became law, dovetailed off one another, stating, “Notwithstanding any provision of this Act to the contrary, the Department or the Board of Medicine or Board of Osteopathic Medicine and Surgery shall not by order, rule, or other method require a physician applicant or licensee under its jurisdiction to maintain a national or regional certification that is not otherwise specifically required to maintain a national or regional certification that is not otherwise specifically required in this article before it issues a license or license renewal to that physician applicant or licensee under this article,” and “An insurer that delivers, issues for delivery, or renews in this state a health insurance policy or health maintenance that issues a health maintenance contract shall not require a condition precedent to the payment or reimbursement of a claim under the policy or contract that an allopathic or osteopathic physician maintain a national or regional certification not otherwise specifically required for licensure.”

Missouri

Missouri joins Oklahoma as one of the first in the country to enact anti-MOC legislation. In July 2016, the state enacted law that stated, “The state shall not require any form of maintenance of licensure as a condition of physician licensure including requiring any form of maintenance of licensure tied to maintenance of certification. Current requirements including continuing medical education shall suffice to demonstrate professional competency. The state shall not require any form of specialty medical board certification or any maintenance of certification to practice medicine within the state. There shall be no discrimination by the state board of registration for the healing arts or any other state agency against physicians who do not maintain specialty medical board certification including recertification.” In 2017, the legislature introduced a bill that made it so “No provision of law shall be construed as to require any form of maintenance of licensure as a condition of physician licensure, reimbursement, employment, or admitting privileges at a hospital in this state, including requiring any form of maintenance of certification. Current requirements, including continuing medical education, shall suffice to demonstrate professional competency.”

New York

New York AO4914 states, “It shall be an improper practice for a governing body of a hospital to refuse to act upon an application or to deny or to withhold staff membership or professional privileges of a physician solely because such physician is not board-certified. A health care plan may not refuse to approve an application from a physician to participate in the in-network portion of the health care plan's network solely because such physician is not board-certified.” The legislation was introduced into the Assembly and referred to the health committee.

North Carolina

In Summer 2016, the North Carolina legislature presented HB 728 to the Governor for signature. The Governor signed, and the law states that the North Carolina Medical Board “shall not deny a licensee’s annual registration based solely on the licensee’s failure to become board certified.”

Ohio

The Patient Access Expansion Act (HB 273) prohibits a physician from being required to secure MOC as a condition of obtaining licensure, reimbursement, employment, or obtaining admitting privileges or surgical privileges at a hospital or health care facility. It was introduced in the House in June 2017 and referred to the Health Committee, where it is currently sitting.

Oklahoma

In April 2016, SB 1148 was signed into Oklahoma law. The legislation states: "Nothing in the Oklahoma Allopathic Medical and Surgical Licensure and Supervision Act shall be construed as to require a physician to secure a Maintenance of Certification (MOC) as a condition of licensure, reimbursement, employment, or admitting privileges at a hospital in this state. For the purposes of this subsection, Maintenance of Certification (MOC) shall mean a continuing education program measuring core competencies in the practice of medicine and surgery and approved by a nationally recognized accrediting organization."

Rhode Island

The Rhode Island general assembly introduced H 5671 in January 2017, which states in relevant part, “The state and its instrumentalities are prohibited from requiring any form of specialty medical board certification and any maintenance of certification to practice medicine within the state. Within the state, there shall be no discrimination by the board of medical licensure and discipline, or any other agency or facility which accepts state funds, against physicians who do not maintain specialty medical board certification, including re-certification.”

Tennessee

This legislation was signed into law on May 25, 2017, and states that “No facility licensed under this chapter shall deny a physician a hospital's staff privileges based solely on the physician's decision not to participate in any form of maintenance of licensure, including requiring any form of maintenance of licensure tied to maintenance of certification. This section does not prevent a facility's credentials committee from requiring physicians licensed pursuant to title 63, chapters 6 and 9, to meet continuing medical education requirements, as outlined in the rules of the appropriate state licensing board.”

Texas

The Texas bill was recently signed by the Governor and will become law on January 1, 2018. The relevant part of the legislation states, Except as otherwise provided by this section, the following entities may not differentiate between physicians based on a physician's maintenance of certification: if the facility or hospital has an organized medical staff or a process for credentialing physicians; …. (b) An entity described by Subsection (a) may differentiate between physicians based on a physician's maintenance of certification if: (1) the entity's designation under law or certification or accreditation by a national certifying or accrediting organization is contingent on the entity requiring a specific maintenance of certification by physicians seeking staff privileges or credentialing at the entity; and (2) the differentiation is limited to those physicians whose maintenance of certification is required for the entity's designation, certification, or accreditation as described by Subdivision (1). (c) An entity described by Subsection (a) may differentiate between physicians based on a physician's maintenance of certification if the voting physician members of the entity's organized medical staff vote to authorize the differentiation. (d) An authorization described by Subsection (c) may: (1) be made only by the voting physician members of the entity's organized medical staff and not by the entity's governing body, administration, or any other person; (2) subject to Subsection (e), establish terms applicable to the entity's differentiation, including: (A) appropriate grandfathering provisions; and (B) limiting the differentiation to certain medical specialties; and (3) be rescinded at any time by a vote of the voting physician members of the entity's organized medical staff.

Conclusion

The anti-MOC rhetoric is real, and heated. A quick google search shows at least two websites dedicated to the anti-MOC movement. Change Board Recertification, seems to collect articles about MOC and re-publish them all in one convenient website. The DOCS4Patient Care Foundation shows that – presumably in an attempt to gain more followers – proponents of anti-MOC legislation like to frame the issue as “right to care” laws, an interesting tactic.

Proponents of the anti-MOC laws believe that MOC restricts patient access by forcing older physicians into early retirement. It is our belief, however, that with the speed of innovation today, MOC is a critical part of patient care and upholding the Hippocratic Oath. By allowing physicians to continue practicing medicine without requiring MOC, patients may be put at risk.

In an attempt to keep up with the changing landscape, we will provide regular updates of bills introduced, passed and the subsequent regulations that are adopted.

Comments

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Opinions are irrelevant and we should focus on the facts. There is plenty of evidence that multiple years of residency training followed by initial board certification is a valid tool in our profession to improve patient care. There is no evidence that MOC for recertification is a valid tool that improves patient care or outcomes. Emotional pleas to the contrary which cite patient safety as a concern do not change the gross lack of evidence to support MOC.

Like the Dr Seuss story, MOC simply started as an optional gold star to distinguish between Sneetches. It has morphed into multi-million dollar behemoth that has lost it's way. Linking a scientifically invalid process to the legal regulation of medicine is just wrong. Leave the Gold stars to the children's book.

and that is ALL MOC is, is a religion based on belief, as the facts clearly show that it has nothing to do with keeping up with what YOU ARE doing. " It is our belief,........ "
Clearly by limiting physicians on hospital staff, insurance panels and substituting them with NP/PAs there is supposed to be an improvement in care????? BS, Money is saved and patient care is placed at risk.
Regarding the " speed of innovation today" all this MOC is about selling the newest products at greatest costs! There has NEVER been cheap insulin because of the new innovations......and little improvement in the treatment over pork or bovine extracted insulin. The MOC cycles insure new products over old. The assumption that physicians do not keep up without MOC is nonsense. ACCME monitors all CME required by STATES to be absolved YEARLY to be unbiased! The corporate machines are there to extract $$$ where ever possible-MOC is no different.
Certification has NEVER been demonstrated to improve patient care. In Europe there is NO ABMS presence and oddly enough this population has cheaper care, less neonatal morbidity, longer lifespans and NO ABMS MOC!
The ABMS is a $600 million a year industry with NO purpose but pure waste!
There is evidence that all Certification does is create greater payouts when a lawsuit is lost-"cause you are certified"!
The truly bad physicians HIDE behind Certification and dupe patients into such things as getting cancer treatment while having NO cancer-see http://www.medscape.com/features/slideshow/physicians-of-the-year2015#page=14
Physician Who Gave Unneeded Chemo Sentenced to 45 Years

In July, Farid Fata, MD, was sentenced to 45 years in prison in Detroit for administering excessive or unnecessary chemotherapy to 543 patients. Some of them he deliberately misdiagnosed with cancer. In addition to enduring needless chemotherapy, the patients suffered anguish at the possibility of death. The massive criminal scheme netted at least $17 million from Medicare and private insurers. One witness said the oncologist overtreated her father to the point of killing him.
Yes GREED is the problem in US medicine and the ABMS are leaders in this lesson.

I would agree with your belief. The problem is not MOC. The problem is the lobbying efforts of physician groups against a standard of measurement for quality of care and maintaining currency in best practice. MOC does not restrict patient access. And maybe some older physicians should retire as obviously we are not able to prevent or control certain life threatening chronic like asthma, diabetes and obesity. Why shouldn't we expect our healthcare providers to stay current on best practices and continue to demonstrate it.